Organization
THINK BIG YOUTH ORGANIZATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEMMENTRICE JEFFERSON (DIRECTOR)
(912) 610-3466
Entity
Organization
Contact information
Practice address
9784 E OGLETHORPE HWY STE C, MIDWAY, GA 31320-4546
(912) 610-3466
Mailing address
9784 E OGLETHORPE HWY STE C, MIDWAY, GA 31320-4546
(912) 610-3466
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020
COUNSELING SERVICES
—
Enumeration date
10/05/2020
Last updated
10/05/2020
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